Vasectomy is the only form of reliable male contraception, and the most effective type of contraception for men and women.
This safe and simple procedure is done under local anesthesia. Complications or side effects are unusual, making it an increasingly popular choice for long-term contraception among couples who want to avoid pregnancy without undergoing other medical treatments or procedures such as tubal ligation or hormonal birth control implants or pills.
Many men believe that getting a vasectomy will stop them from producing semen (the ejaculate), but this is a common misconception. After a vasectomy, ejaculation still feels and looks the same as before because semen is produced by the prostate gland and seminal vesicle glands, which are located downstream from the vasectomy site, just below the bladder. The only difference is Semen no longer contains sperm.
You’ll be glad to know that it has a success rate of over 99% But before you breathe a sigh of relief, there’s one crucial step you shouldn’t skip: the semen test. The test, which should be done about 12-14 weeks after the vasectomy, will determine if there are any sperm present in the semen. This is important as it confirms the success of the surgery in preventing pregnancy. But the good news is, if the semen test is negative, the likelihood of ever getting pregnant is very low – around 1 in 3,000. So you can finally enjoy peace of mind and full control over your reproductive health.
Let’s look at the anatomy. A vasectomy blocks the vas deferens, the two tubes that carry sperm from each testicle to the ejaculatory ducts under the bladder.
Introducing no-scalpel and open-ended Vasectomy.
Vasectomy requires that both vas deferens or tubes, are cut and sealed.
The first step is to get to a tube on one side (starting with the left) and bring a loop out through the skin. There are two ways of doing this: traditional vasectomy and no-scalpel vasectomy.
Traditional vasectomy requires two separate incisions on each side of the scrotum to access the vas deferens. This method leaves two wounds that require stitches. In contrast, no-scalpel vasectomy only requires one small incision in the middle of the scrotum. This method is less invasive and has a quicker recovery time. Most vasectomies these days are performed using the no-scalpel technique.
The next step is to block the tube so that sperm cannot pass through. This can be done by occluding (sealing) both the upper and lower ends of the vas deferens (called a closed vasectomy) or by sealing just the upper end while leaving the lower end open (‘open-ended’). The upper end can be sealed with its outside connective tissue layer using a clip or absorbable stitch.
The following flow diagram shows you the steps required to achieve an open-ended vasectomy using an absorbable stitch.
How do you play ball with your partner who drops the hint that she is ‘over hormones?’ How do you handle the bombshell? ‘Honey, I’m pregnant!’ Men are not used to grabbing a front-row seat in the contraception department. ‘No worries, mate, she’ll be right’ doesn’t work for contraception.
The top ‘six’ reasons why vasectomy is the contraception of choice for many men:
You will, understandably, want a cast-iron guarantee there will be no future pregnancy. However, the vas deferens (tube) can rarely re-join (recanalization).
The first three months are the most common time for recanalisation. These failures should be known failures after the post-vasectomy semen test. The failure rate of known failure should be well under 1%.
Late Failure refers to pregnancy after getting the all-clear from the post-vasectomy sample. Thankfully, this is rare at less than 1 in 2,000 lifelong risk of pregnancy. Note that the failure rate of other methods of contraception is quoted over a 12-month period. Vasectomy is remarkably effective.
|Risk of Pregnancy PER YEAR||Main Benefits||Main Risks||Issues|
|Combined Pill||7% per year (normal use)||Low Failure Rate, can reduce period bleeding, can have cycles back-to-back. Often Beneficial for conditions like acne or hirsutism.||Deep Vein Thrombosis & Cardiovascular Risk Factors to evaluate include Body mass index, Smoking, Migraine with aura, Family history, increasing age, high BP, Cholesterol, Diabetes, kidney disease etc.||Can forget to take the pill.|
|Progestogen Only Pill||9% per year (normal use)||Used as a 2nd line oral contraceptive when the combined pill is not recommended. No increased cardiovascular or thrombotic risks.||Australian licensed mini pills need to be taken in a 3 hour window each day.||The minipill is unforgiving when forgotten – failure rates are high.|
|Progestogen Injection||6% per year||No increased cardiovascular or thrombotic risks. Periods often disappear completely within 12 months.||Progestogenic side effects are usually manageable but women may sometimes report weight gain, mood or changes. Periods often erratic to start with.||3 monthly visits to your doctor & practice nurse to get the injection. Need a pregnancy test if late for your next injection.|
|Progestogen Implant (rod)||0.05% per year||Periods often disappear completely within 12 months.||Persistent bleeding beyond 6 months in around 15% of women may require the implant to be removed.||3 yearly implant in the inner side of the left upper arm.|
|Intrauterine Device – Mirena||0.2% per year||Periods usually disappear completely within 12 months – often good for heavy or painful periods.||Risk of uterine perforation is around 1 in 1000. Rarely infection or migration of the device.||5 yearly re-insertion. Few GPs currently provide this service & most women need a referral to a gynaecologist.|
|Condom, Cap, Ring||Condom 18% Cap 12%||Caps, Diaphgragm & Vaginal Ring.||no systemic risks. Higher rate of failure than many other methods of contraception.||Suits only a few women and couples – comes down to personal preference & guidance on use from a health practitioner.|
|Female Sterilisation||0.5% risk||Low failure rate at around 1 in 200||Higher failure rate & risks (surgical + Anaesthetic) than The Snip.||Day Case in a hospital.|
|Vasectomy||1 in 3000 lifetime (after test)||The lowest failure rate. Men can get involved!||Post vasectomy discomfort affects around 1 in 50 guys.||The most important thing is to continue contraception until you get the all-clear after the semen analysis.|
Vasectomy is a surgical procedure, and as with all surgery, side effects are possible.
Bleeding. Haematoma describes internal bleeding that is sufficient to lead to scrotal pain and visible swelling. The haematoma will eventually go away on its own, although a large haematoma may take several months to resolve. On the other hand, minor pin-point bleeding from the skin is a minor inconvenience that is usually solved by pinching the skin for 10 minutes.
All Vasectomists ‘get’ haematomas, but a large Haematoma is rare.
Infection. Thankfully, infection after vasectomy is rarer than most people think. Pain, mild swelling and bruising are more likely to reflect temporary inflammatory healing and usually go away without antibiotics. Clinical assessment and experience dictate when to start antibiotics – but vasectomy specialists find that antibiotics are rarely required.
An abscess is very rare but requires surgical drainage. Fornier’s gangrene is (thankfully) exceptionally rare, perhaps 1 in 10,000, although the risk is higher in men with poorly controlled diabetes.
Seriously? Do you have time for a baby? At the very least, ensure good contraception that will last until you and/or your partner no longer require contraception.
Your dad may have referred to ‘blue balls’ – now, mostly, a thing of the past.
Good try! Dogs don’t get a vasectomy, they get the lot taken out (castration). The word ‘Sterilisation” includes both vasectomy and castration, which is one reason why vasectomy doctors don’t use the word. Check the history of vasectomy for other reasons including eugenics.
Testosterone is completely unaffected.
Semen is the same afterwards in all five senses.
Up to 6% of men who have had a vasectomy seek a reversal within ten years of the procedure.
Dr Beatty ranks risk factors for regret in the following order:
Couples with babies might want to defer a vasectomy until their baby is more than six months of age because of the small risk of Sudden Infant Death Syndrome (SIDS). The risk of SIDS (‘cot death’) is around 1 in 2000 babies. The age of maximum risk occurs between the age of 2 and 4 months of age.
Younger men, particularly who have not fathered a child, are much higher risk of seeking reversal later. A comparison of men who a vasectomy compared with men who had a reversal of vasectomy found that Vasectomy reversal ‘occurred 12.5 times more often in men who underwent vasectomy in their 20s than in men who were older.’
Therefore, younger men should have a chat with friends and family – just as with any major life decision. Try to get some balanced answers by asking older men and fathers. Try to postpone the decision and use other reliable forms of contraception.
A minority of Vasectomy doctors wouod be comfortable, after a long consent process, operating on a 20-year-old man who has not fathered a child, whilst others doctors would not operate until age 30.
Dr Beatty’s ‘age threshold’ is around 24-25 years of age for a man who has not fathered. Anecdotally, this is about the same age as other vasectomy doctors in Australia.
A man of that age wouldn’t be seeking a vasectomy without being sure now. However, he will be asked to accept the possibility that you would seek a reversal at some time in the future. After all, that’s what the research shows. Saying that ‘I know that I will definitely never ever want kids’ isn’t acknowledging that they might change their mind in the future, whereas saying ‘I know there is a chance that I may change my mind later, but I still want to get a vasectomy’ is acknowledging uncertainty.
Brain development, and life events may change your priorities.
Consider a vasectomy when you are certain that you do not wish to father any or any more children.
However, some men consider sperm banking prior to vasectomy as a form of insurance against unknown unknowns.
The costs of sperm banking is approximately $600 for the initial banking, and $500 per year for freezing.
A referral from your GP may help to reduce the costs of the service.
Men rarely want to pay thousands of dollars over a 10 year period banking their sperm ‘just in case.’ What risk are you prepared to accept? What price would you pay for certainty? Younger men who have not fathered should consider putting off the vasectomy. However, a young man who is determined to get a vasectomy should certainly consider sperm banking because the risk of regret is so high.
Tests prior to sperm banking will generally include a semen analysis and blood tests. The precise blood tests required vary between providers, and include:
Vasectomy can be reversed though is expensive and does not always work.
The success rate of vasectomy reversal ranges from 50% to 90% depending on the length of time that has elapsed since the vasectomy. Reversal is more successful after a Vasectomy performed <5 years ago compared to a vasectomy performed >10 years ago.
See your doctor for a referral to a urologist who performs vasectomy reversals. Most capital cities have a few urologists who perform reversals, with perhaps 2 to 3 who perform most of them.
You will want to research the success rate of the reversal specialists in your area. A 2021 study of 107 reversal providers in the USA found that ‘ Only one provider provided complete information as defined by REVERSAL score of 12, with the majority (61.7%) of providers achieving score ≤6.’ They concluded that ‘There is significant lack of transparency in publicly available information from VR practices.’
The total price for vasectomy reversal is typically in the order of $10,000 AUD with a medicare rebate of under $1,000. Private health cover can reduce out of pocket expenses by several thousand dollars. The ‘out of pocket’ for a reversal may be as low as $3,000.